Report Shows Texas Lagging in Long-Term Care Quality

Editor's note: This story has been updated throughout to include a response from the Department of Aging and Disability Services.

Texas ranks third-worst in the nation on quality of long-term care for elderly and disabled people, according to a new AARP report released Thursday — five days before a state commission convenes for a public hearing on the Department of Aging and Disability Services.

The report scores states and the District of Columbia in five categories of services for elderly people and those with disabilities, and Texas' rankings are all over the board. The state ranks among the top 10 in the country for affordability and access. But it places 49th for quality of care and quality of life — a category including factors like staff turnover in nursing homes.

Overall, Texas is ranked 30th nationwide, falling from 28th three years ago, the first time AARP released such a report.

The ranking comes amid a critical period for the department, which licenses and regulates Texas service providers like nursing homes and state-supported living centers for the intellectually disabled. DADS is up for review this year by the Texas Sunset Advisory Commission, the body that reviews state agencies and recommends changes, continuations and potential abolishment.

Staffers at the commission, which comprises legislators and members of the public, released initial recommendations last month that lambasted the department for major shortcomings. The meetings next week offer the public a chance to comment before the commission decides whether to accept the recommendations in August ahead of the 2015 legislative session.

In particular, the commission’s report came down hard on the department’s failure to sanction nursing homes, state-supported living centers and home-based programs that violate regulations: In fiscal year 2013, the department recorded 37,919 violations but took just 225 disciplinary actions. “DADS needs to step up to the plate and more aggressively take on its role as a regulator,” the staffers wrote.

In a conference call with reporters Wednesday, Susan Reinhard, director of AARP's Public Policy Institute, said the quality of life and care category is “a challenging area” for many states. “Ideally, these services maximize positive outcomes — that consumers are treated with respect and that people can have their personal preferences honored,” she added.

Texas scores particularly poorly on certain individual indicators like nursing home staff turnover, where the state ranks 50th — its rate of 72 percent is nearly double the national average. This factor lies at the root of several of Texas’ other problems, as a high turnover rate reduces staffers' ability to keep medical conditions from escalating unnecessarily.

“If you have continuity of staff, what we see is that conditions that might become problematic can often be identified early on,” said Amanda Fredriksen, associate state director of advocacy at the AARP’s Texas branch.

Fredriksen said much of the responsibility to fix Texas’ poor rankings lies with the state government.

“We need to see more attention from the Legislature and from the Department of Aging and Disability Services,” she said.

Department spokeswoman Melissa Gale said Thursday that the agency "is committed to ensuring that nursing facilities in Texas provide safe, quality services to their residents."

"If we find nursing facilities are violating regulations and not meeting their obligations to residents, we hold them accountable to the extent allowed by state and/or federal law," Gale said in an email.

Disclosure: AARP is a corporate sponsor of The Texas Tribune. A complete list of Texas Tribune donors and sponsors can be viewed here.